Sweating and skin problems and PD

APDA

https://www.apdaparkinson.org/article/sweating-and-skin-problems/

Suggestions to alleviate excessive sweating

In some cases, episodes of profuse sweating take place as a medication dose is wearing off or during a period of dyskinesias. If the sweating episodes appear to be related to medication timing, then treatment may revolve around changing medication timing or dosages to reduce OFF time or dyskinesias. 

In other cases, the episodes occur at random, or occur primarily during sleep. Basic lifestyle recommendations to aid in the management of excessive sweating include:

  • wearing light, airy clothing

  • taking cool or lukewarm showers

  • drinking ample water

  • using moisture wicking and cooling sheets, pajamas, clothing and socks. These products are made of materials that absorb more water and dry faster than standard fabrics and can be helpful for some people with excessive sweating

  • avoiding sweat triggers including spicy foods, caffeine and alcohol

If these simple suggestions are not effective, and often they are not, additional strategies are available. The following are treatments recommended for those suffering from excessive sweating in the general population, and have not been tested specifically in people with PD. In addition, these treatments are generally focal (applied to a particular area) and may not be as effective if sweating is widespread. Discuss these options with your physician:

  • Prescription-strength anti-perspirant – Almost all anti-perspirants available over-the-counter use an aluminum-based compound as their active ingredient. If these are not effective, there are anti-perspirants with a higher aluminum content that are available by a prescription. Both over-the-counter and prescription strength anti-perspirants can be used in sweaty areas other than under the arms, such as the soles of the feet

  • Topical glycopyrrolate – This is a gel (it also comes in the form of a medication-infused cloth) containing an anti-cholinergic medication that can be applied to areas that are typically sweaty. Anti-cholinergic medications can have side effects, including dry mouth, constipation and blurry vision, particularly as people age. However, a topical medication is thought to have fewer side effects than an oral pill whose impact is more widespread in the body

  • Oral medications – Despite the fact that side effects may occur, oral anti-cholinergics (such as oral glycopyrrolate) to control sweating may be appropriate for certain people with PD

  • Botulinum toxin injections of the underarms and palms are an effective treatment of excessive sweating in those areas

  • A variety of procedures are available to reduce sweating. These include:

    • Iontopheresis – used for excessive sweating primarily of the hands and feet. This is a medical device that applies a current across the skin which increases the permeability of the skin, or the ability of substances to pass through the skin. Treatments, conducted by placing the hands and feet in tap water and applying a current, have been shown to decrease sweating. If this is not effective, sometimes an anti-cholinergic medication is added to the water. Treatments must be repeated frequently (about once a week), but after an initial period, can be done at home

    • MiraDry is a handheld device that delivers microwave energy to specific areas of the body thereby destroying the underlying sweat glands. Laser treatments can be used for this purpose as wel

“Skin and Sweating Problems in Parkinson’s,” by Dr. Ronald Pearce, and Caroline McMahon
Published by Parkinson’s UK, May 2015
This 3-page information sheet explains that sometimes people with Parkinson’s have problems with their skin, and how much or how little they sweat, the symptoms you may experience and what you can do to manage them.

“Excessive Sweating in Parkinson’s Patients,” by Dr. Maria De Leon
Published by defeatparkinsons.com, January 7, 2015
This blog post by neurologist and young onset Parkinson’s patient, Dr. Maria De Leon, explains why we sweat normally, what goes wrong in Parkinson’s disease, what you can do to minimize sweating, and ways to avoid body odor due to excessive sweating.

 

“Hyperhidrosis Treatment Overview”
Published by the International Hyperhidrosis Society
This is the home page for the International Hyperhidrosis Society, a non-profit organization focused on hyperhidrosis, research, treatment options and clinical trials. Their motto: Know Sweat.

 

“Skin Changes”
Published by the Parkinson’s Disease Foundation
This short webpage lists symptoms and what you can do for oily, flaky or inflamed skin, dry skin, excessive sweating, and too little perspiration.  Advice is given to be screened regularly for melanomas.

 

“Skin, Scalp and Sweating”
Published by Parkinson’s Victoria (Australia)
This single webpage has symptoms and management tips for oily skin and scalp, seborrhoeic dermatitis, and too little or too much sweat.

 

“Sweating (Parkinson’s disease)”
Published by What-When-How, In Depth Tutorials and Information
How the autonomic nervous system regulates many systems, including temperature control, and how Parkinson’s change the body’s temperature regulatory mechanisms leading to symptoms such as hyperhidrosis.

 

“What is Hyperhidrosis?”
Published by the Hyperhidrosis Support Group(UK)
This website has up-to-date information on affected areas and treatment options for anyone living with hyperhidrosis (excessive sweating), as well as medical staff providing treatment options.x

 

Podcasts and Webinars

“Is It Related to PD? Runny Noses, Skin Changes and Overlooked PD Symptoms”
By the Parkinson’s Foundation, April 18, 2017
In this 1-hour webinar neurologist W. Lawrence Severt discusses non-motor and non-traditional symptoms of PD, the variability of presentations among patients, pharmacological and non-pharmacological treatments, as well as recent changes in the management of PD.

 

Expert-Level Resources

“Hyperhidrosis in Parkinson’s disease,” by P. Schestatsky, et. al.
Movement Disorders, October 2006
Good summary of prevalence of sweating in a small group of PD patients showing that excessive sweating in PD concurs with decreased activation of sweat glands in the palms of the hands and suggests that axial hyperhidrosis could be a compensatory phenomenon for reduced sympathetic function in the extremities. Registration with PubMed required to read the full article.

 

“The Relationship between Thermoregulation and REM Sleep Behavior Disorder in Parkinson’s Disease,” by George Zhong, et. al.
PLOS One, August 21, 2013
This open access article provides a thorough description of how thermoregulation occurs and what systems are affected by Parkinson’s disease.

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